Galassi A R, Tamburino C, Grassi R, Monaco A, Russo G, Ierna S M, Calvi V, Giuffrida G
Istituto di Cardiologia, Università degli Studi, Catania.
Cardiologia. 1996 Nov;41(11):1097-105.
The recent implantation of intravascular devices (stents), during percutaneous transluminal coronary angioplasty (PTCA), has shown favourable results, decreasing acute occlusion and restenosis during follow-up as compared to PTCA alone. The aim of the study was to assess in a single center the efficacy of the implantation of a Palmaz-Schatz stent in a homogeneous group of patients and to assess the incidence of angiographic restenosis. Fifty-four consecutive patients (mean age 57 +/- 12 years) with single vessel coronary disease at angiography and with objective evidence of myocardial ischemia were studied. According to the duration of angiographic follow-up, patients were divided into two groups: Group I (mean 6 +/- 3 months) and Group II (mean 29 +/- 5 months). Stent implantation was performed electively in 43 patients (80%) while in the remaining 11 (20%) as "bail out" in a failed PTCA. Sixty-five stents were implanted in 54 patients of whom 1 stent in 47 patients (87%), 2 stents in 3 patients (6%) and 3 stents in the remaining 4 patients (7%). The stents were placed in the anterior descending of the left coronary artery in 32 patients (59%), left circumflex coronary artery in 8 patients (15%) and right coronary artery in 14 patients (26%). Mean diameter stenosis before stent implantation was 88 +/- 6% and decreased significantly to 4 +/- 7% after stent implantation (p < 0.0001). No major complications such as death, Q wave myocardial infarction, emergency coronary artery bypass graft or stroke occurred during the procedure. Minor complications such as wrong positioning of the stent, non occlusive acute thrombosis, non Q wave myocardial infarction and transient vessel occlusion occurred in 9% of treated patients. At follow-up, in Group I, 8 patient of 43 (18%) showed a > or = 50% restenosis and 10 patients < 50% restenosis; in the remaining 25 patients no variations in the caliber of the vessel were observed. In Group II, 2 patients of 11 (18%) showed a > or = 50% restenosis and 1 patient < 50% restenosis; in the remaining 8 patients no variations in the caliber of the vessel were observed. Complications during medium and long-term follow-up included total vessel occlusion in 1 patient. In conclusion, these data confirm that the Palmaz-Schatz stent may be implanted with high success and low complication rate. The percentage of restenosis, occurring in near 20% of the cases, remains an unresolved problem, despite the implantation of such intravascular devices.
近期在经皮腔内冠状动脉成形术（PTCA）期间植入血管内装置（支架）已显示出良好效果，与单纯PTCA相比，随访期间急性闭塞和再狭窄发生率降低。本研究的目的是在单一中心评估在一组同质患者中植入帕尔马兹 - 施塔茨支架的疗效，并评估血管造影再狭窄的发生率。对54例连续患者（平均年龄57±12岁）进行了研究，这些患者在血管造影时患有单支冠状动脉疾病且有心肌缺血的客观证据。根据血管造影随访时间，患者分为两组：第一组（平均6±3个月）和第二组（平均29±5个月）。43例患者（80%）选择性地进行了支架植入，其余11例（20%）在PTCA失败时作为“补救措施”植入。54例患者共植入65枚支架，其中47例患者植入1枚支架（87%），3例患者植入2枚支架（6%），其余4例患者植入3枚支架（7%）。32例患者（59%）的支架置于左冠状动脉前降支，8例患者（15%）置于左旋支冠状动脉，14例患者（26%）置于右冠状动脉。支架植入前平均直径狭窄为88±6%，植入后显著降至4±7%（p<0.0001）。手术过程中未发生死亡、Q波心肌梗死、急诊冠状动脉搭桥或中风等重大并发症。9%的治疗患者出现了支架位置不当、非闭塞性急性血栓形成、非Q波心肌梗死和短暂性血管闭塞等轻微并发症。随访时，在第一组中，43例患者中有8例（18%）显示再狭窄≥50%，10例患者再狭窄<50%；其余25例患者未观察到血管内径变化。在第二组中，11例患者中有2例（18%）显示再狭窄≥50%，1例患者再狭窄<50%；其余8例患者未观察到血管内径变化。中长期随访期间的并发症包括1例患者出现血管完全闭塞。总之，这些数据证实帕尔马兹 - 施塔茨支架可以高成功率和低并发症率植入。尽管植入了这种血管内装置，但近20%的病例中出现的再狭窄百分比仍然是一个未解决的问题。
